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J Perinatol. 2017 Sep;37(9):994-998. doi: 10.1038/jp.2017.75. Epub 2017 Jun 15.

Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele.

Author information

1
University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
2
Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.
3
Department of General Surgery, Mayo Clinic, Rochester, MN, USA.
4
Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA.
5
Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.
6
Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, NC, USA.
7
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
8
Department of Radiology, Boston Children's Hospital, Boston, MA, USA.

Abstract

OBJECTIVE:

Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure.

STUDY DESIGN:

Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs).

RESULTS:

Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal-fetal surgery is unfair to the future child. Most (94%) would recommend prenatal fetoscopic over open or postnatal MMC closure for a hypothetical fetoscopic technique that had similar shunt rates (40%) but decreased maternal morbidity. When the hypothetical shunt rate for fetoscopy was increased to 60%, physicians were split (49% fetoscopy versus 45% open). Views about burdens and fairness correlated with the likelihood of recommending postnatal or fetoscopic over open closure.

CONCLUSION:

Individual and specialty-specific values may influence recommendations about prenatal surgery.

PMID:
28617430
DOI:
10.1038/jp.2017.75
[Indexed for MEDLINE]

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